Survey of ophthalmology最新文献

Ocular infections are a common cause of visual morbidity worldwide and continue to pose significant diagnostic and therapeutic challenges. Metagenomic next-generation sequencing (mNGS) enables unbiased detection of wide range of pathogens; however, its diagnostic utility in ocular infections warrant further evaluation. We evaluate the diagnostic performance of mNGS, highlighting its advantages, limitations, and future directions for the clinical application. Twenty-one studies involving 1219 eyes were included. mNGS positivity rates ranged from 10% to 94%. Sensitivity ranged from 15% to 100% and specificity from 12% to 100%. Viral pathogens were the most frequently detected (15 out of 21 studies), followed by bacteria (14 out of 21), fungi (10 out of 21), and parasites (6 out of 21). A broad spectrum of pathogens at both the genus and species levels was identified. mNGS also helps in assessing AMR-associated genes and mutations linked to therapy susceptibility. mNGS appears to be a valuable tool for pathogen indentification in ocular infections, particularly for organisms undetectable by conventional diagnostic methods, although careful interpretation is required. Overall, mNGS demonstrated promising diagnostic performance across different types of ocular infections. Larger, well-designed studies employing standardized protocols are needed to address current limitations and to enhance the clinical applicability of mNGS in routine clinical practice.

MicroRNAs (miRNAs) are emerging as important regulators in pterygium, a fibrovascular growth of the conjunctiva with high recurrence rates. This systematic review with selective quantitative synthesis aimed to identify differentially expressed miRNAs as potential biomarkers and therapeutic targets of pterygium. A comprehensive search of PubMed and Scopus (January 2010-March 2024) identified 17 eligible studies for the systematic review, of which 13 case-control studies, involving 789 pterygium patients and 546 controls, contributed quantitative data for synthesis. Following PRISMA guidelines, 4 miRNAs showed differential expression, with miR-21 and miR-199a-5p upregulated and miR-200a and miR-221-3p downregulated. Quantitative synthesis across independent studies was feasible for miR-200a, whereas miR-21, miR-199a-5p, and miR-221-3p were supported by single-study evidence. A literature review confirmed that the identified miRNAs regulate several target genes-TGF-β1, ZEB1, ZEB2, CDKN1B, and MAP3K11-which are implicated in pterygium pathogenesis. The enriched pathways identified included cell proliferation, inflammation, angiogenesis, and epithelial-mesenchymal transition, which have been associated with pterygium. Despite heterogeneity across included studies, these findings enhance understanding of pterygium pathogenesis. The identified miRNAs represent promising candidates for diagnostic and therapeutic exploration, warranting further validation in large-scale, longitudinal studies. This work lays the foundation for future miRNA-based clinical research in pterygium management.

Age-related macular degeneration (AMD) is a leading cause of blindness in developed countries and a growing global health concern. The multifactorial nature of AMD calls for integrative multi-omics approaches. We summarize studies employing multi-omics in AMD. A comprehensive search in PubMed and Scopus databases identified 561 records with multi-omics criteria, of which duplicates, unrelated and unavailable articles were excluded, resulting in 33 reports. Quality was assessed following the Office of Health Assessment and Translation (OHAT) method, and data was synthesized through standardized evidence tables. Across the reviewed reports, multi-omics approaches were applied to non-clinical and clinical samples, including ocular and systemic fluids. Methodological trends included the widespread use of causal inference approaches (e.g., Mendelian randomization and Bayesian colocalization) and increasing adoption of spatial and single-cell resolution techniques. Converging molecular patterns consistently suggested inflammation, complement activation, angiogenesis, lipid dysregulation, and mitochondrial dysfunction as key processes underlying AMD. Integration of genetic risk with proteomic and metabolomic alterations, enabled the identification of candidate diagnostic and prognostic biomarkers such as carboxyethylpyrrole and PRMT3. Additionally, this review revealed opportunities for personalized medicine in AMD patient stratification, improvement of prediction models, and therapeutic personalization; however, heterogeneity was noted across studies, particularly regarding sample source (systemic vs. ocular), analytical platforms, integration strategies, and ancestry representation. Despite this variability, this review illustrates how integrating multiple omics layers provides a comprehensive and multidimensional understanding of AMD pathology, advancing research towards better diagnosis, prognosis, and therapeutics for these patients.

Foundation models represent a new frontier in ophthalmic artificial intelligence, enabling learning of transferable features from large unlabelled imaging datasets for flexible application to varying downstream tasks. We systematically analyze the evolution of ophthalmic foundation models across 12 distinct models developed between 2022 and July, 2025. We examine advances in modality integration (unimodal, multimodal to vision-language), pretraining objectives (generative versus contrastive approaches) and supervision strategies (image and text guided). Emerging techniques such as imaging modality agnostic encoders, synthetic data augmentation, and computationally efficient architectures improved model performance and generalisability. Overall, we observed a clear shift from domain-specific unimodal approaches towards modality-agnostic foundation models guided by clinical text. Future directions include wider modality integration, higher dimensional inputs (spatially and temporally), diverse pretraining, and standardised benchmark datasets. In synthesizing these trends, this review offers the conceptual and technical grounding to support both clinicians and researchers in ophthalmic foundation model design, selection, and application.

The concept of ocular frailty remains inadequately defined with respect to its clinical manifestations, etiological pathways, and consequential impacts. We delineate the concept of ocular frailty in order to furnish a well-defined and operationalizable conceptual basis for advancing research in the aging population. A total of 15 articles were included for analysis and synthesis. The attributes of ocular frailty were hypofunction, loss of resilience, association with systemic frailty, potential reversibility or modifiability, and multidimensionality. Antecedents of ocular frailty were classified into 2 categories, namely, sociodemographic characteristics and comorbidity. Consequences of ocular frailty include 4 themes: increased risk of adverse outcomes, high tendency for depression, low autonomy, and the possibility of social isolation. Ocular frailty, an age-related manifestation characterized by diminished ocular functional capacity, represents a state of heightened vulnerability in the visual system. The outcomes of this concept analysis facilitate theoretical clarification and operational delineation of ocular frailty. Ocular frailty, clarified through Rodgers' evolutionary concept analysis, is defined by its attributes, antecedents, and consequences, providing a structured framework for clinical risk stratification and future research in geriatric populations.

Graves-associated upper eyelid retraction (GAUER) is a functionally and cosmetically significant manifestation of thyroid eye disease. This scoping review maps the breadth of evidence on medical and surgical management of GAUER, synthesizes outcomes, and identifies evidence gaps. A systematic search identified 65 studies published between 1965 and 2025. Studies were categorized as medical or surgical interventions, with Marginal Reflex Distance 1 (MRD1) serving as the most consistently reported outcome for weighted analysis. Among medical interventions, triamcinolone acetonide remains the most widely studied, though recent randomized clinical trials suggest betamethasone achieves faster and longer-lasting improvement with fewer injections. Botulinum toxin A and hyaluronic acid fillers offer safe, reversible options for transient or mild retraction, while the biologic teprotumumab shows modest but consistent benefit, particularly in muscle-predominant disease. Surgical correction remains the standard for fibrotic or refractory cases, with full-thickness anterior blepharotomy and levator-Müller complex recession yielding the most predictable, durable, and aesthetically balanced results. Interpretation of available data is limited by methodological heterogeneity and a lack of standardized endpoints. Aesthetic outcomes were inconsistently reported. Future prospective comparative studies incorporating both functional and aesthetic outcomes are essential to establish evidence-based, phase-specific treatment strategies for GAUER.

A 38-year-old man with poorly controlled type 2 diabetes mellitus and arterial hypertension on semaglutide presented with acute, painless, vision loss in the left eye. Ophthalmic examination revealed optic disc edema (ODE) in the left eye and optic disc pallor (ODP) in the right eye, accompanied by severe nonproliferative diabetic retinopathy and cystoid macular edema in both eyes. The combination of ODE in one eye and ODP in the fellow eye raised concern for the Foster Kennedy syndrome secondary to an intracranial mass; however, neuroimaging and systemic evaluation were unremarkable. Ultimately, it was decided the ODP was due to a prior unrecognized non-arteritic anterior ischemic optic neuropathy (NAION) event, and the ODE was the result of an acute NAION in the symptomatic fellow eye (i.e. pseudo-Foster Kennedy syndrome).

Rhegmatogenous retinal detachment (RRD) is a major cause of vision loss requiring prompt surgical intervention. Recent advances in multimodal retinal imaging, especially macular and peripheral optical coherence tomography (OCT), have significantly improved our understanding of the various factors and biomarkers influencing the clinical outcomes after RRD repair. Several visual disturbances, such as metamorphopsia and aniseikonia, typically persist despite successful reattachment, significantly impacting patients' quality of life. Factors influencing recovery include the timing of surgery, the extent of retinal displacement, and structural integrity of retinal layers. Additionally, recent research is increasingly highlighting the relevant role of numerous OCT biomarkers, including hyperreflective dots, ellipsoid zone, external limiting membrane and outer retinal disruption, and bacillary layer detachment in prognosis. We provide an overview on the above-mentioned factors implied in RRD-related postsurgical prognosis in order to optimize clinical practice.

The corneal triple procedure, combining keratoplasty, cataract extraction, and intraocular lens implantation, remains a valuable option for patients with concurrent corneal opacity and cataract. We synthesize historical and contemporary evidence on penetrating keratoplasty (PKP), anterior lamellar keratoplasty (ALK), and endothelial keratoplasty (EK) triple procedures, highlighting their indications, surgical techniques, outcomes, and evolving trends. PKP triple is indicated for full-thickness scarring, keratoconus with central scarring, and cases with anterior segment abnormalities, but remains technically demanding due to open-sky cataract surgery and postoperative refractive unpredictability. ALK triple offers tectonic and visual rehabilitation in stromal disorders sparing the endothelium, though technically challenging. EK triple procedures, particularly Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty, are increasingly preferred in endothelial disorders such as Fuchs endothelial corneal dystrophy, offering faster recovery, more predictable refraction, and better graft survival. Advances in capsulotomy, nucleus management, intraocular lens power calculation, and perioperative strategies have improved safety and refractive outcomes across triple procedures. Long-term studies reveal that although visual and anatomical success rates remain high, complications such as graft rejection, glaucoma, and posterior capsular opacification persist. Careful patient selection and tailored surgical planning are essential, as triple procedures continue to evolve toward safer and more predictable outcomes.

Intra-arterial chemotherapy (IAC) has emerged as a targeted alternative to conventional systemic chemotherapy (CC) for retinoblastoma, but their comparative effectiveness and safety remain incompletely defined. This systematic review and meta-analysis evaluated whether IAC is superior to CC for survival, globe preservation, and metastasis prevention in pediatric intraocular retinoblastoma. We searched PubMed, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar from inception to June 1, 2025, for English-language human studies directly comparing IAC with CC and reporting at least one primary outcome. Eligible designs included randomized trials and comparative cohort or observational studies. Risk of bias was assessed using Cochrane tools, and random-effects models generated pooled risk ratios with 95% confidence intervals. Twelve comparative studies including 6,261 children and more than 5,000 treated eyes met the criteria. Compared with CC, IAC was associated with higher overall survival (risk ratio 1.12, p < 0.00001) and event-free survival (risk ratio 1.43, p < 0.0001), higher globe salvage (risk ratio 1.33, p < 0.00001), and a lower risk of enucleation (risk ratio 1.69, p < 0.00001), particularly in advanced International Classification of Retinoblastoma Group D and E eyes. IAC also reduced metastatic events by 54% (risk ratio 0.46, p = 0.03). Heterogeneity was low across primary outcomes, and no meaningful publication bias was detected. These findings indicate that IAC provides superior survival, ocular preservation, and metastatic protection compared with CC, supporting its use as a preferred frontline or adjunctive therapy for intraocular retinoblastoma where technical expertise and resources permit.